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On Thursday, Oct. 9, 2025, representatives from California Improvement Network (CIN) partner organizations gathered in downtown Los Angeles to learn from experts and one another about how to cultivate trauma-informed organizations that can fully support a thriving health workforce.
Trauma is a universal experience that affects patients, community members, and health care and service providers. The talented, interdisciplinary teams who provide care often carry their own personal challenges into a workplace that is increasingly demanding all within a social climate that feels unstable and turbulent. Now more than ever, health care teams need holistic support to thrive in the workplace and provide excellent care and services to patients and clients.
Trauma-informed leadership and organizational practices are essential for sustaining the health workforce and ensuring continued access to quality care and support for communities. California’s health ecosystem operates within systems and structures that unintentionally re-traumatize both people receiving care and those who provide it. Without a trauma-informed approach, health organizations risk perpetuating harm, eroding organizational culture and trust, and losing the very workforce necessary to advance access to quality care.
During the meeting, Sadie Elisseou, MD, Founder and CEO, Trauma-Informed Practices, described how chronic stress in work environments contributes to workforce burnout and shared pathways for transforming workplaces into trauma-informed, resilience-oriented environments. These three takeaways showcase why trauma-informed workplaces are important to California’s health ecosystem:
Trauma is widespread and systemic
Elisseou emphasized that trauma is not only an individual experience but something that is shaped and perpetuated by the structures and systems people interact with, including the work environment. In health settings, in particular, the workforce is consistently exposed to high levels of stress, trauma, and suffering. She noted that “…about 50% of people in [the health care] field report symptoms of burnout. About 20% of people in the US have symptoms of depressive or anxiety disorder. And the WHO estimates that these symptoms of depression and anxiety cost the global economy over $1 trillion per year in lost productivity.” While some stress can be positive and a normal part of life, like preparing for a new job, persistent exposure to stress can be toxic to our brain, body and behaviors leading to trauma.
Elisseou also highlighted research on the impacts of Adverse Childhood Experiences (ACEs), noting, “…more work has been done to expand the concept of ACEs to include more structural exposures like community violence and racism and to include broader populations within their study.”
Trauma is now more broadly defined and widely recognized as both an individual and systemic experience, which, if unaddressed, can lead to burnout and other issues. For the health workforce, this means exposure to daily stress within the workplace and to external and structural factors compounding its effects.
Building trauma-informed health organizations is foundational to advancing health care delivery and sustaining a resilient workforce.
Trauma-informed approach offers frameworks for healing and resilience
Trauma-informed practices are designed through evidence-based frameworks that have been shown to foster psychological safety and increase engagement, improve workforce satisfaction, and connect the workforce to organizational missions. Staff and leaders across the health ecosystem witness pain, suffering, loss, and injustice all within the context of their own personal experiences, past or present. A trauma-informed approach recognizes this and provides a path toward healing and resilience.
Elisseou highlighted two trauma-informed frameworks to help leaders take action within their organizations to foster a more compassionate, safe, and understanding workplace that allows the workforce to thrive. Both frameworks were developed by Substance Abuse and Mental Health Services Health Administration (SAMHSA). Elisseou also used a case study to illustrate how these frameworks can be used in practice – see case study below.
The first framework, “Four Rs” framework, helps leaders understand and acknowledge the impacts of trauma on individuals and communities.
- Realize: Acknowledge the widespread impact of trauma on individuals and communities.
- Recognize: Identify signs and symptoms of trauma in clients, families, staff, and others involved in the system.
- Respond: Provide appropriate responses to trauma, creating a safe and non-judgmental environment.
- Resist Re-Traumatization: Implement practices and policies to prevent re-traumatization and create trauma-informed systems.
The second framework, Six Principles of Trauma-Informed Care, is applicable to the health workforce and patients. Leaders can use this framework to foster a culture of empathy, trust, and support, which is crucial for the well-being of teams.
- Safety: Ensuring physical and emotional safety.
- Trustworthiness and transparency: Opening with transparency and ensuring actions match words.
- Peer support: Sharing experiences with others to allow for authentic interactions.
- Collaboration and mutuality: Leveling power differences between staff and ensuring every voice is heard and valued.
- Empowerment voice and choice: Empowering others and giving them autonomy.
- Cultural, historical, and gender issues: Being open to learning and adapting and recognizing the importance of everyone’s experiences.
Leaders set the tone for trauma-informed approaches
Trauma-informed leadership requires empathy, transparency, and emotional regulation. Being a trauma-informed leader requires you to shift “…from the traditional and accusatory ‘what is wrong with you?’ to a more compassionate inquiry of ‘what happened to you?’” To shift the lens from blame to compassion and curiosity, Elisseou introduced the NURSE empathy framework as a tool leaders can use to practice empathy and build workforce well-being.
The NURSE framework allows individuals to express empathy and understanding while witnessing signs of trauma.
- Name the emotion that the person in front of you might be feeling.
- Express understanding, respect for that person, and support for that person.
- Explore the issue further with that person as appropriate.
Health care is in crisis with funding cuts, access concerns, and workforce shortages converging with widespread burnout and trauma. It is no longer optional to integrate trauma-informed approaches into organizational culture – it is crucial. Now is the time to incorporate trauma-informed principles into every level of organizational leadership and culture. By becoming a trauma-informed organization, we can create a culture where health care workers feel supported and safe, enabling them to sustain compassion and resilience, which are the backbone of health care organizations.
Case Study: Story of Andy and Sophie
Let’s meet Andy and Sophie. Andy is a senior director at a suicide prevention community center, and Sophie was recently hired as a project manager for a new crisis helpline initiative.
Sophie has had a lot going on in her personal life, her mom just had a stroke, her daughter just started college but is not doing well, her basement recently flooded, she hasn’t been sleeping well, and she’s feeling the pressure from her workload.
Andy noticed Sophie’s shoulders tightening over the past few weeks (recognize), but nothing prepared him for the moment she burst into his office, voice raised and eyes shiny with exhaustion. A rushed email about a deadline change had pushed her past her limit. As her words tumbled out—anger, frustration, fear—Andy felt his own pulse spike. Instead of reacting, he took a breath, grounded himself (respond), and spoke gently: “This sounds incredibly stressful. I can understand why you’re upset. I’m here to support you.” The shift was immediate. Sophie’s posture softened, her voice steadied, and for the first time she admitted, “I just haven’t been able to catch a break. I need help.”
Andy explained the sudden leadership shift behind the new deadline and invited Sophie to shape a plan that felt manageable. Together they redistributed tasks, brought in peer support, and set up check-ins that emphasized partnership rather than oversight (safety and collaboration). Over time, Sophie accessed additional resources, found a coworker she could lean on (peer support), and reconnected with the mission that had drawn her to the work (empowerment and choice).
A moment that could have fractured trust instead became a turning point—proof that honesty, calm, and shared problem-solving can transform a crisis into connection. Andy intentionally resisted any dynamic that could reinforce shame, fear, or helplessness (resist re-traumatization). He avoided punitive reactions, power-over language, minimizing her experience, and ensured that their interactions strengthened, not threatened, their working relationship.
